Provider Demographics
NPI:1548876220
Name:ANDERSON, SETH (OD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 S PULASKI RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4219
Mailing Address - Country:US
Mailing Address - Phone:773-284-9844
Mailing Address - Fax:
Practice Address - Street 1:5153 S PULASKI RD UNIT B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4219
Practice Address - Country:US
Practice Address - Phone:773-284-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist